SPINE TRAUMA neurogenic shock _PROF Niraj Kumar NEUROANESTH & NEUROINTENSIVE TRAUMA CENTRE AIIMS ND скачать в хорошем качестве

SPINE TRAUMA neurogenic shock _PROF Niraj Kumar NEUROANESTH & NEUROINTENSIVE TRAUMA CENTRE AIIMS ND

00:00 Intro to Webinars 04:35 Objectives of Talk 08:33 Vagus Nerve Details 13:32 Trauma Management 17:48 Primary Survey 22:57 Fiber Optic Tool 26:57 Injury Severity 30:44 Neurogenic Shock 40:36 Spine Clearance 44:41 Autonomic Feature 53:11 Spine Surgeon 01:02:34 Ruling Out Shock 01:11:12 Secretion Removal C Spine Injury Management Dr Niraj discussed a case scenario of a 26-year-old male with a cervical spine cord injury following a motor vehicle accident. He presented with hypotension, bradycardia, tachypnea, labored breathing, and quadriplegia, which are typical signs of an upper-level spinal cord injury. Dr Niraj outlined the objectives of the talk, which include discussing neuroanatomy, pathophysiology, and the management of such injuries, emphasizing the importance of immobilizing the cervical spine and performing a primary survey. He also highlighted the epidemiology and common causes of spinal cord injuries, noting that motor vehicle accidents and falls from height are the most prevalent. - ANS Overview Dr Niraj discuss the sympathetic and parasympathetic systems. He explained their functions, origins, and pathways, emphasizing the importance of understanding neuroanatomy for cervical spine and coronary conditions. Dr Niraj highlighted the role of the vagus nerve in parasympathetic function and the descending pathways from the brain stem to control heart rate and blood pressure.-- Spine Trauma Management Protocols Dr Niraj explained the concepts of primary and secondary injuries in spine trauma, emphasizing that while primary injuries are due to mechanical forces at the time of accident, secondary injuries occur due to inflammation and free radical formation. He outlined the management protocol for trauma patients, which includes spine immobilization, airway and breathing support, and maintaining adequate blood pressure and oxygen delivery to prevent secondary damage to the spinal cord. Dr Niraj also discussed the importance and highlighted the challenges in airway management advocating for the use of video laryngoscopy in emergency situations. Neurogenic Shock Pathophysiology Overview Dr Niraj explained the pathophysiology of neurogenic shock, a hemodynamic condition characterized by hypotension and bradycardia, which occurs due to disruption of the descending sympathetic pathways following cervical spine injury. He clarified that while spinal shock involves neurological function loss, neurogenic shock is a distinct hemodynamic phenomenon. Dr Niraj emphasized the importance of differentiating neurogenic shock from hypovolemic shock, noting that while both can occur in trauma patients, neurogenic shock presents with hypotension and bradycardia (often below 60 bpm), warm and dry skin, and is associated with intact parasympathetic activity. He also highlighted that neurogenic shock may coexist with hypovolemic shock, requiring fluid resuscitation and blood transfusion for management. Bradycardia and Hypotension Management Dr Niraj discussed the management of patients with bradycardia and hypotension, emphasizing the importance of fluid resuscitation and vasopressor use to maintain mean arterial pressure around 85-90 mmHg for the first week of injury. He explained that the initial fluid resuscitation should include 2 liters of fluid, followed by assessment of CVP, and that excessive fluid administration could lead to complications. Dr Niraj also covered the process of clearing a patient's cervical spine, either through clinical examination using the NEXUS criteria or radiological examination, and outlined a stepwise approach to the management of spinal fractures based on stability and neurological deficits. Spinal Cord Injury Shock Management Dr Niraj discussed autonomic dysreflexia, a chronic complication of spinal trauma occurring above the T6 level, characterized by severe hypertension due to unopposed sympathetic activity below the injury site and parasympathetic overactivity above it. He explained the management of neurogenic shock, a condition of hypotension and bradycardia seen in acute spinal cord injuries above T6, caused by sympathetic loss and vasodilation, and emphasized the importance of fluid resuscitation and vasopressor use. Dr Tapesh raised questions about the mechanisms of neurogenic shock and its differentiation from hypovolemic shock, which Dr Niraj addressed by explaining the physiological reasons for hypotension in different injury levels and the importance of ruling out other causes of shock. He addressed respiratory challenges in patients with cervical spine injuries, emphasizing the role of diaphragm and abdominal muscles in ventilation, and the need for physiotherapy and cough assist devices to prevent respiratory fa